■系统评价和荟萃分析。
■与战斗创伤相关的颌面部损伤有增加的趋势。在颌面复合体中,下颌骨是战斗中最有可能受损的结构。因此,可以通过许多选择来重建结构性缺陷。这些包括血管化骨移植物(VBG),非血管化植骨(NVBG),同种异体植入物,重建杆和牵引成骨。这项研究旨在确定下颌骨重建在与创伤相关的缺损中的常见方式和功效。
■在Pubmed,Prospero,dynamed,DARE,EMBASE,COCHRANE和BMJ数据库。
■共有六篇文章符合纳入标准,确定了165例需要下颌骨重建的患者。非血管化的骨移植物(n=137)是最常见的方法,其次是使用Dacron尿道膜骨网托盘(n=24)和额顶移植物(n=4)收获回肠c骨碎片。6项试验中有5项的荟萃分析显示总成功率为85%(95%CI79-90;I2=59%)。总共有13%(n=22)的重建完全或部分失败,而21%(n=34)的患者遭受了术后并发症。
■NVBG是一种实用的,具有成本效益和有利的方法的战区管理下颌骨缺损的成功率与民用文献中报道的相当。然而,一般创伤原则优先排除危及生命的伤害。适当考虑患者因素,手术因素,在与战斗有关的下颌骨缺损的一线管理中需要可用的资源。
UNASSIGNED: Systematic Review and Meta-Analysis.
UNASSIGNED: There has been an increasing trend in maxillofacial injuries associated with combat trauma. Within the maxillofacial complex, the mandible is the most likely structure to be damaged during combat. The structural deficits as a result can be reconstructed with many options. These include vascularised bone grafts (VBGs), non-vascularised bone grafts (NVBGs), alloplastic implants, reconstruction bars and distraction osteogenesis. This study aimed to determine the common modality and efficacy of mandibular reconstruction in combat trauma-related defects.
UNASSIGNED: A literature search was conducted on Pubmed, Prospero, Dynamed, DARE, EMBASE, COCHRANE and BMJ databases.
UNASSIGNED: A total of six articles met the inclusion criteria identifying 165 patients requiring mandibular reconstruction. Non-vascularised iliac bone graft (n = 137) was the most common method followed by ileac crest bone chips harvest using Dacron urethran osteomesh tray (n = 24) and frontoparietal grafts (n = 4). Meta-analysis of five out of six trials demonstrated an overall success rate of 85% (95% CI 79-90; I2 = 59%). A total of 13% (n = 22) of reconstructions failed either completely or partially and 21% (n = 34) of patients suffered postoperative complications.
UNASSIGNED: NVBGs are a practical, cost-effective and favourable method of war zone management of mandibular defects with success rates comparable to those reported in the civilian literature. However, general trauma principles take precedence to rule out life-threatening injuries. Due consideration of patient factors, surgical factors, and available resources are required in the first-line management of combat-related mandibular defects.